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Clinical Investigations in Critical Care |

A Multicenter Description of Intermediate-Care Patients*: Comparison With ICU Low-Risk Monitor Patients

Christopher Junker, MD; Jack E. Zimmerman, MD; Carlos Alzola, MS; Elizabeth A. Draper, MS; Douglas P. Wagner, PhD
Author and Funding Information

*From the Department of Anesthesiology and Critical Care Medicine (Dr. Junker), George Washington University Medical Center, Washington, DC; the Department of Health Evaluation Sciences (Dr. Wagner), University of Virginia, Charlottesville, VA; the Dyne Corp (Ms. Draper) Reston, VA; and APACHE Medical Systems, Inc, (Dr. Zimmerman and Mr. Alzola), McLean, VA.

Correspondence to: Christopher Junker, MD, Department of Anesthesiology and Critical Care Medicine, The George Washington University Medical Center, 901 23rd St NW, Washington, DC 20037; e-mail:junkers@erols.com



Chest. 2002;121(4):1253-1261. doi:10.1378/chest.121.4.1253
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Study objectives: To describe the characteristics and outcomes of patients admitted to intermediate-care areas (ICAs) and to compare them with those of ICU patients who receive monitoring only on day 1 and are at a low risk (ie, < 10%) for receiving subsequent active life-supporting therapy (ie, low-risk monitor patients).

Design: Nonrandomized, retrospective, cohort study.

Setting: Thirteen US teaching hospitals and 19 nonteaching hospitals.

Patients: A consecutive sample of 8,971 patients at 37 ICAs and 5,116 low-risk (ie, < 10%) monitor patients at 59 ICUs in 32 US hospitals.

Interventions: None.

Measurements and results: We recorded demographic and clinical characteristics, resource use, and outcomes for the ICA and ICU low-risk monitor patients. Patient data and outcomes for this study were collected concurrently or retrospectively. ICA and ICU low-risk monitor patients were similar in regard to gender, race, and frequency of comorbitities, but ICA patients were significantly (p < 0.001) older, had fewer physiologic abnormalities (mean acute physiology score, 16.7 vs 19.8, respectively), and were more frequently admitted due to nonoperative diagnoses. The mean length of stay for ICA patients was significantly longer (3.9 days) than for ICU low-risk monitor patients (2.6 days; p < 0.001). The hospital mortality rate was significantly higher for ICA patients (3.1%) compared to ICU low-risk monitor patients (2.3%; p = 0.002).

Conclusions: The clinical features of ICA patients are similar, but not identical to, those of less severely ill ICU monitor patients. Comparisons of hospital death rates and lengths of stay for these patients should be adjusted for characteristics that previously have been shown to influence these outcomes.

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